High War Survival Rate Catches U.S. Off Guard: ; More Americans Come Home Alive, but Many Have Sever

Jun 25, 11:35 PM

Current Headlines: By Marilynn Marchione

Tens of thousands of U.S. troops are coming home from war alive but wounded, often tragically. More than 800 of them have lost an arm, a leg, fingers or toes. More than 100 are blind. Dozens need tubes and machines to keep them alive. Hundreds are disfigured by burns, and thousands have brain injuries and mangled minds.

These are America's war wounded. Depending on how you count them, they number between 35,000 and 53,000.

Survival rates today are even higher than the record levels set early in the war, thanks to body armor and better care. For every American soldier or Marine killed in Iraq, 15 others have survived illness or injury there. However, more of them are coming home, with injuries of a scope and magnitude the government did not predict and is now struggling to treat.

"If we left Iraq tomorrow, we would have the legacy of all these people for many years to come," said Dr. Jeffrey Drazen, editor-in- chief of the New England Journal of Medicine and an adviser to the U.S. Department of Veterans Affairs. "The military simply wasn't prepared for its own success" at keeping severely wounded soldiers alive, he said.

Unlike in previous wars, few of the wounded troops have been shot. The signature weapon of this war - the improvised explosive device, or IED - has left a signature wound: traumatic brain injury.

Soldiers hit in the head or knocked out by blasts - "getting your bell rung" is the military euphemism - sometimes have no visible wounds but a fog of war in their minds. They can be addled, irritable, depressed and unaware they are impaired.

Only an estimated 2,000 cases of brain injury have been treated, but doctors think many less obvious cases have gone undetected. One small study found that more than half of one group of wounded troops arriving at Walter Reed Army Medical Center had brain injuries. Around the nation, a new effort is underway to check every returning man and woman for this possibility.

Some of those on active duty might have subtle brain damage that was missed when they were treated for more visible wounds. Half of those wounded in action returned to duty within 72 hours - before some brain injuries might have been apparent. The military just adopted new procedures to spot these cases, too.

Back home, concerns grow about care. The Walter Reed hospital outpatient scandal and problems with some VA nursing homes have led Republicans and Democrats to call for better care for this new crop of veterans.

A lucky few get Cadillac care at one of the VA's four polytrauma centers, where the most complex wounds are treated with state-of- the-art techniques and whiz-bang devices like "power knee" or "smart ankle" prosthetics. Others battle bureaucracy to see doctors or get basic benefits in less ideal settings.

Mental-health problems loom large. More than a third of troops received psychological counseling shortly after returning from Iraq, and a third of those were diagnosed with a problem, a recent Pentagon study found. The government plans to add 200 psychologists and social workers to help treat post-traumatic stress disorder and other issues.

No one knows what the ultimate cost will be. Harvard University economist Linda Bilmes estimates the lifetime health-care tab for these troops will be $250 billion to $650 billion - a wide range but a huge sum no matter how you slice it.

Who are the wounded?

Lee Jones, 24, of Lumberton, N.C., was severely burned on the face, hands, feet and legs when his Humvee was hit by an IED two years ago. A partial amputee with speech and other problems from a severe brain injury, he now does work therapy delivering mail at a VA hospital and tries to re-establish life in a nearby apartment with a wife and baby daughter.

Marine Cpl. Joshua Pitcher, 22, from upstate New York, is a Purple Heart recipient who returned to Iraq after he was shot in 2005. Half of his skull was removed to allow his brain to swell as he now recovers from a brain injury and shrapnel wounds from a grenade blast in February.

Maj. Thomas Deierlein, 39, is a New York City marketing executive who served five years after graduating from West Point. Twelve years later, called up as a reservist, he nearly died from bullet wounds that shattered his pelvis, leaving him with a colostomy and learning how to walk again.

Joseph "Jay" Briseno, 24, of Manassas Park, Va., was shot in the back of the neck by an Iraqi in the early months of the war. One of the war's most severely wounded, he is now a quadriplegic, on a breathing machine, blind and unable to speak, but aware of what has happened to him.

As of June 2, 25,830 troops had been wounded in action. Of these, 7,675 needed airlifts to military hospitals. The rest were treated and remained in Iraq.

There were another 27,103 nonbattle-related air transports. Of those, 7,188 had injuries. Most occurred from vehicle accidents, training or work-related accidents. Ten percent were sports injuries, said Dr. Michael Kilpatrick, who tracks this information for the Defense Department.

Nearly 20,000 of these "nonhostile" airlifts were for illnesses or medical issues: general symptoms like fever or pain needing tests or evaluation; back problems; psychological problems adjusting to being in a war zone; "effective psychoses" (not able to function or care for themselves); neuroses; respiratory or chest symptoms; depression; head and neck problems (including traumatic brain injury); epilepsy; infections; and muscle pulls and strains.

"I don't want to try to say these are not war-related," Kilpatrick said. "Being in the military is a very physically demanding job."

For stress-related problems, the military tries "three hots and a cot" - warm meals and a chance to sleep. Most of the time it works, and troops return to their unit, Kilpatrick said.

Of the troops air-evacuated to the military hospital in Landstuhl, Germany, 20 percent return to Iraq and 80 percent go back to the United States for more care or a disability discharge.

Of the half-million troops who have left active duty and are eligible for VA health care, about one-third have sought it. The most complicated cases end up at one of the four polytrauma centers, in Tampa, Fla.; Richmond, Va.; Palo Alto, Calif.; and Minneapolis.

These were formed after doctors realized they were missing problems - amputees who were confused and unable to put on their prosthetics because of undiagnosed brain injuries, and guys who could remember their therapy dog's name but not their doctor's, or who could carry on a conversation but not recall what they had for breakfast.

Troops at these hospitals have an average of six major impairments and 10 specialists treating them.

Most of these injuries are caused by IED blasts, which send a pressurized air wave through delicate tissues like the brain, sometimes sending it smacking against the inside of the skull and shearing fragile nerve connections that control speech, vision, reasoning, memory and other functions. Lungs, eardrums, spinal cords - virtually anything - can be damaged by the pressure wave. Injuries also come from collapsing buildings, flying debris, heat, burns or inhaled gases and vapors.

"Many of these you can't see on an X-ray," such as glass shards that can cause internal bleeding, Scott said.

In previous wars, one of every five to seven troops surviving a war-related wound had a traumatic brain injury, the military estimates. It's much higher in this war.

A pilot project at Walter Reed in 2003 to screen 155 patients returning from Iraq found that 62 percent had a brain injury.

(c) 2007 Sunday Gazette - Mail; Charleston, W.V.. Provided by ProQuest Information and Learning. All rights Reserved.